Lead Claims Investigator - Fraud Detection

Placements24; Pretoria; Hybrid; ZAR 900,000 - 1,200,000; Full time

Benefits offered by this job

Hybrid work model

Competitive salary

Job summary

Placements24 is seeking an experienced Lead Claims Investigator to join a Pretoria-based fraud detection unit. You will lead and mentor investigators, oversee complex fraud investigations across lines of business, and develop advanced techniques to safeguard company assets.

You will analyze claims data, maintain high professional standards, and liaise with law enforcement and regulatory bodies. A strong forensic, regulatory, and data-analysis background is essential for success.

Qualifications

• Minimum 8 years in insurance claims investigation with at least 3 years in a supervisory role.
• Degree in Criminology, Law Enforcement, Forensic Science or related field.
• Strong knowledge of South African fraud laws and regulatory requirements.

Responsibilities

• Lead and mentor a team of investigators on case strategy and best practices.
• Conduct and oversee complex investigations across insurance lines.
• Analyze claims data and financial records to identify fraud indicators.
• Develop advanced investigation techniques and training for staff.
• Prepare detailed reports with findings, evidence, and recommendations.
• Liaise with law enforcement, legal counsel and regulators as needed.
• Contribute to fraud detection model enhancements and maintain confidentiality.

Skills

Fraud detection methodologies

Investigative techniques

Data analysis

Forensic investigation

Leadership

Education

Degree in Criminology or related field

Tools

Case management software

Job description

About the Role

Our client, a leading insurance provider, is seeking an experienced and meticulous Lead Claims Investigator to join their dedicated fraud detection unit in Pretoria, Gauteng . This critical role involves leading investigations into potentially fraudulent insurance claims, ensuring the protection of company assets and upholding the integrity of the claims process. The Lead Investigator will manage a team of investigators, oversee complex case assignments, and develop advanced investigation strategies. A strong understanding of forensic investigation techniques, data analysis, and regulatory compliance is essential. This position offers the chance to make a significant impact in combating insurance fraud and contributing to the financial health of our client's operations within the vibrant Pretoria landscape.

Key Responsibilities

• Lead and mentor a team of claims investigators, providing guidance on case strategy and best practices.
• Conduct in-depth investigations into suspected fraudulent insurance claims across various lines of business.
• Analyze claim data, financial records, and supporting documentation to identify patterns and indicators of fraud.
• Develop and implement advanced investigation techniques, including surveillance, interviews, and background checks.
• Prepare detailed investigation reports, documenting findings, evidence, and recommendations.
• Liaise effectively with law enforcement agencies, legal counsel, and regulatory bodies.
• Develop and deliver training programs on fraud detection and prevention to internal stakeholders.
• Contribute to the refinement of fraud detection models and systems.
• Maintain confidentiality and ethical standards throughout all investigations.

Requirements

• A relevant degree in Criminology, Law Enforcement, Forensic Science, or a related field.
• Minimum of 8 years of experience in insurance claims investigation, with at least 3 years in a supervisory or lead role.
• Proven expertise in fraud detection methodologies and investigative techniques.
• Strong analytical and critical thinking skills with exceptional attention to detail.
• Excellent report writing and presentation abilities.
• Experience in interviewing and interrogation techniques.
• Knowledge of relevant South African laws and regulations pertaining to fraud and insurance.
• Ability to work effectively both independently and as part of a collaborative team.
• Must reside in or be willing to commute to Pretoria, Gauteng , and potentially travel as needed.

Benefits

• Competitive salary and performance-based bonuses.
• Comprehensive medical aid and provident fund benefits.
• Opportunities for advanced training and professional certifications.
• A stimulating work environment focused on combating financial crime.
• Hybrid work model offering flexibility and work-life balance in Pretoria .
• Access to cutting-edge investigative tools and resources.